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Öğe Can the suburethral mesh angle be used to predict transobturator tape results?(SPRINGER HEIDELBERG, 2017) Ilhan, Tolgay Tuyan; Ilhan, Tuerkan Saymaz; Ucar, Mustafa Gazi; Kebapcilar, Ayseguel; Kivrik, Mithat; Celik, CetinPurpose The primary aim of our study was to evaluate mesh movement on ultrasonography and to compare the relationship between suburethral mesh angle and incontinence recurrence. Methods This study was carried out at the University of Selcuk, Konya, Turkey, Beyhekim State Hospital, Konya, Turkey and the Mus State Hospital between September 2012 and January 2015. In total, the results from 109 patients were evaluated in the statistical analysis. The suburethral mesh angle (SMA) is the angle between the two arms of the trans- obturator tape (TOT) mesh under the urethra. This angle was measured at 10 days, 6 months and 1 year after surgery. Potential risk factors for incontinence recurrence and SMA were compared in logistic regression models. The best cut-off value for SMA was calculated to predict incontinence recurrence. Results The mean resting SMA did not change with time during follow-up (p = 0.373). However, when comparing coughing SMA values, the first day measurement was significantly different from the other measurements. Another comparison was performed according to the cSMA value at each visit. The difference was significant from the first day. Lung disease and the change in the SMA (cSMA) on day 10 were significant predictors of treatment failure. The cSMA on day 10 to predict first-year treatment failure was 10 degrees, with 61% sensitivity and 96% specificity. Conclusions Measurement of the SMA can be used as a prognostic factor in TOT surgery. Further research is required to determine the importance of SMA as a prognostic factor.Öğe Diagnosis and Management of Isolated Tubal Torsion Is Salpingectomy Mandatory?(SCI PRINTERS & PUBL INC, 2018) Ucar, Mustafa Gazi; Celik, Mehmet; Sanlikan, Fatih; Ilhan, Tolgay Tuyan; Gocmen, Ahmet; Celik, CetinOBJECTIVE: To review the clinical characteristics of patients with isolated fallopian tube torsion (IFTT). STUDY DESIGN: We conducted a retrospective study of a consecutive series of IFTT cases presenting at 2 tertiary referral centers. All patients underwent laparoscopic assessment, and the fallopian tube and its ligamentous support were gently untwisted to assess ischemic lesions. Patients were classified based on the following 3 criteria: complete recovery (Group A), partial recovery (Group B), and without any recovery (Group C). RESULTS: Our series consisted of 9 patients. Group A (2 cases) and Group B (5 cases) were managed conservatively. Two patients were assigned to group C and underwent laparoscopic salpingectomy. During early postoperative period, in the conservatively managed group 4 patients underwent hysterosalpingography examination, and both fallopian tubes were found to be patent. One of these 4 patients had a spontaneous pregnancy and delivered a healthy infant, and another patient had a miscarriage at 6 weeks' gestation. Imaging revealed no pathological findings in the remaining 3 virgins in the conservatively managed group. No infections, peritonitis, thromboembolic events, or other complications occurred during the follow-up period. CONCLUSION: Conservative management of IFTT can be considered a safe option, even if little evidence of recovery is observed after detorsion.Öğe Diagnostic Value of Visual Examination of Cervical Polypoid Lesions and Predictors of Misdiagnosis(LIPPINCOTT WILLIAMS & WILKINS, 2016) Ucar, Mustafa Gazi; Ilhan, Tolgay Tuyan; Ucar, Rahime Merve; Karabagli, Pinar; Celik, CetinObjectives This study reviews occasions when cervical polyps removed in an outpatient setting proved not to be cervical polyps histologically. We aimed to identify any anatomical and/or clinical characteristics that predict "incorrect diagnosis in general practice. Methods A retrospective study of consecutive 345 patients who were initially diagnosed with cervical polyps based on a routine gynecological examination in an outpatient setting was included. After histopathological examination, the patients were divided into 2 groups: those with cervical (correct diagnosis, n = 307) and falsely diagnosed with cervical polyps (FDP, n = 38). These 2 groups were compared in terms of age, signs and symptoms, and size of the polypoid lesions. Results The initial clinical diagnosis was correct in 307, giving a positive predictive value of 89%. There were no significant difference between the groups with respect to age of patients (p = 0.59) and the size of the lesions (p = 0.42). According to our study, among misdiagnosed patients, nabothian cysts and cervicitis were the most common histological findings; FDPs were more often symptomatic (p < 0.001) and coexisted more frequently with inflammation or ulceration (p < 0.001). All FDPs were developing within the endocervical canal. There were no instances of FDPs that arise from ectocervix. Symptomatic polypoids have a higher risk of preliminary misdiagnosis (OR = 13.0; 95% confidence interval, 3.0-55.1). Conclusions All cervical polypoid lesions must be sent to pathology because visual diagnosis is not sufficiently accurate to direct patient care.Öğe Does lymphadenectomy have influence on postoperative body fluid distribution?(ELSEVIER SCIENCE BV, 2017) Ilhan, Tolgay Tuyan; Ucar, Mustafa Gazi; Pekin, Aybike Tazegul; Yilmaz, Setenay Arzu; Kerimoglu, Ozlem Secilmis; Celik, CetinObjective: We compared the fluid volume parameters in women undergoing gynaecological surgery for benign and malignant conditions before and after surgery using bioelectrical impedance vectors. Study design: A total of 181 patients were enrolled. In all, 89 patients had surgery for benign conditions and 92 patients underwent oncological procedures, including lymph node dissection, for malignant diseases. Bioelectrical impedance analysis (BIA) parameters were measured on the day of hospitalisation before any treatment and at 24h and 1 month after the surgical intervention. The BIA parameters measured included extracellular water (ECW), intracellular water (ICW), and total body water (TBW). Results: TBW increased significantly 1 month after surgery in all cases (p < 0,05 in both group). ECW was significantly higher (p < 0.05) and ICW was significantly lower (p < 0,05) in the malignant group than the benign group. Conclusion: Radical gynaecological surgeries, including lymph node dissection, have a greater effect on body water distribution than surgeries performed for benign conditions. (C) 2017 Elsevier B.V. All rights reserved.Öğe Management of intra-abdominally translocated contraceptive devices, is surgery the only way to treat this problem?(TAYLOR & FRANCIS INC, 2017) Ucar, Mustafa Gazi; Sanlikan, Fatih; Ilhan, Tolgay Tuyan; Gocmen, Ahmet; Celik, CetinThis study was a multi-centre retrospective review of patients with uterine perforation caused by intrauterine contraceptive devices (IUDs). A total of 15 patients were registered, in a seven year period. Among them, five were asymptomatic and the rest were symptomatic. Asymptomatic patients were managed conservatively, except in one case in which the patient requested surgery because she also wanted a tubal ligation. Symptomatic patients all underwent surgery. All the surgeries were elective and all the surgical procedures were initiated laparoscopically. There were seven complications in the surgically managed group: conversion to laparotomy (n=3), bowel injury (n=2), bladder injury (n=1), and wound infection (n=1). Mild and severe adhesions (81.8%), and abscess (18.1%) formation related to translocated IUD (TIUD) were observed during surgery. All the patients were uneventful at 1 to 5 years of follow-up. A TIUD, by causing adhesions, complicates future laparoscopic surgery and increases the likelihood of conversion to laparotomy. While surgery is indicated to prevent TIUD-induced adhesive complications, it may also be the cause of both adhesions and complications, resulting in a vicious cycle. Some asymptomatic women, especially elderly patients with comorbidities, may not need or may be better managed without treatment. IMPACT STATEMENT In this study we try to find an answer for the question of "Should removal of a translocated intrauterine contraceptive device (TIUD) routinely be performed even if patients are asymptomatic?" From only the theoretical point of view there were some reports supporting conservative management in asymptomatic patients. The other studies addressing this issue were case reports including few patients with a short-term follow-up. The novelties of the present study include multi-centre design, detailed clinical and surgical information about the patients and the long period of follow-up. Most clinicians have limited experiences in managing TIUD because perforation is a rare event. So it can be difficult to know exactly what the surgeon will encounter intraoperatively. We undertook this study with the aim of providing a perspective about patients with TIUD for those faced with this situation. This is a descriptive study reporting 15 cases of TIUDs and management. Asymptomatic patients were managed conservatively, and symptomatic patients were operated. There are important implications resulting from this study that in asymptomatic patients leaving the IUD in place may be a reasonable option, mostly as the risk of surgical intervention is quite high with a high rate of complications with surgical management.Öğe A novel insight into the treatment of an intravesical eroded mesh: endoscopic-assisted cystoscopic approach(SPRINGER LONDON LTD, 2016) Ucar, Mustafa Gazi; Avci, Muhittin Eftal; Sanlikan, Fatih[Abstract not Available]Öğe Patient with Three Fallopian Tubes at Right Adnexa(PREMCHAND SHANTIDEVI RESEARCH FOUNDATION, 2017) Ucar, Mustafa Gazi; Ilhan, Tolgay Tuyan; Gul, Ayhan; Korkutan, Candan; Celik, Cetin[Abstract not Available]Öğe Primary Ovarian Malignant Mixed Mullerian Tumour: A Case Report and Brief Review of Literature(PREMCHAND SHANTIDEVI RESEARCH FOUNDATION, 2016) Ucar, Mustafa Gazi; Cakir, Tansel; Ilhan, Tolgay Tuyan; Karabagli, Pinar; Celik, CetinMalignant Mixed Mullerian Tumour of the Ovary (OMMMT), also referred to as carcinosarcoma is a very rare tumour accounting for less than 1% of all ovarian cancers. Due to the rarity of OMMMT, little is known about the disease course and outcome of women with these tumours. It is important to evaluate because of its aggressive behaviour with extremely unfavourable prognosis. These tumours are composed of both malignant epithelial and mesenchymal elements. Current data in the literature is still limited to small case series and case reports, therefore, its optimal treatment is somewhat controversial. In the current report, we introduce a case of OMMMT which was successfully treated with Platinum-based combination chemotherapy after optimal cytoreductive surgery. The clinical manifestations, pathologic characteristics, diagnosis and management of these tumours are reviewed here. Although the most effective treatment is currently unknown, optimal cytoreductive surgery and platinum-based chemotherapy appears to improve the outcomes. Despite the aggressive nature of this tumour and its poor response to the treatment, management works best when cancer is found early. The stage of the disease is the most important prognostic factor. Therefore, the crucial question is how to diagnose the cancer at earlier stages rather than seeking the optimal treatment.Öğe Sexual functioning before and after vaginal hysterectomy to treat pelvic organ prolapse and the effects of vaginal cuff closure techniques: a prospective randomised study(ELSEVIER, 2016) Ucar, Mustafa Gazi; Ilhan, Tolgay Tuyan; Sanlikan, Fatih; Celik, CetinObjective: To evaluate sexual function in women before and after vaginal hysterectomy (VH) and to compare the effects of horizontal and vertical vaginal cuff closure on sexual function. Study Design: Women with uterine prolapse of stage 2 or higher were included to this prospective, randomized study. All patients underwent VH with McCall Culdoplasty and patients were randomized into two groups in terms of the vaginal cuff closure technique employed which is either vertically (group 1, right to left) or horizontally (group 2, anterior to posterior). Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12 Short Form was used to assess sexual function before and 6 months after surgery. Results: A total of 78 women participated, 37 in group 1 and 41 in group 2. Significant improvements in were thus evident in both groups 1 (p = 0.000) and 2 (p = 0.000) after surgery; no significant between group differences were evident. Overall, 61 women (78,2%) had improved PISA-12 scores postoperatively, 11 (14,1%) scored the same pre- and post-operatively, and 6 (7,9%) scored lower postoperatively. Women who reported poorer sexual function postoperatively, or no improvement, had new-onset or worsening dyspareunia and/or incontinence. Conclusion: Most women with uterine prolapse of stage 2 or higher who underwent VH with prolapse repair experienced improved sexual lives postoperatively, regardless of the cuff closure technique used. Although VH to treat POP improves anatomical and sexual concerns, surgery per se may have negative effects on sexual function if new-onset or worsening dyspareunia or incontinence develop. (C) 2016 Elsevier Ireland Ltd. All rights reserved.Öğe Sleep quality of endometrial cancer survivors and the effect of treatments(GALENOS YAYINCILIK, 2017) Ilhan, Tolgay Tuyan; Ucar, Mustafa Gazi; Gul, Ayhan; Ilhan, Turkan Saymaz; Yavas, Guler; Celik, CetinObjective: Sleep disorders affect 54.9% of gynaecologic cancer survivors. The effect of treatment methods on sleep quality is not clear. This study evaluated the sleep quality of survivors of endometrial cancer and compared the effects of different treatments on sleep quality. Materials and Methods: Patients were categorised as surgery (group 1), surgery + brachytherapy (BRT) (group 2), surgery + external beam radiation therapy (EBRT) (group 3), and surgery + EBRT + BRT + chemotherapy (group 4). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The PSQI was completed by the participants before surgery, 1, 3, and 6 months after each treatment was completed. The PSQI scores were compared between the different measurement times and different study groups. Results: This study enrolled 114 patients with a mean age of 58.1 +/- 11 years. The number of participants in each group was 53 (46.5%), 14 (12.3%), 12 (10.5%), and 35 (30.7%), respectively. At baseline, 28 (24.6%) patients reported poor sleep quality. The mean PSQI score reached the maximum level at the second measurement and decreased slightly during follow-up and the change in the PSQI score was significant (p=0.001). Group 3 and group 4 had significantly higher scores from baseline (p<0.008). At time point 3, the differences between the groups were significant. At time point 4, the most prominent effect of treatment on sleep quality was observed in patients with combined chemo-radiotherapy when compared with the other study groups. Conclusion: Most survivors of endometrial cancer are affected by poor sleep quality during their treatment. To improve these patients' quality of life, this disorder must be considered at each visit and tailored care plans should be developed to meet the women's needs. Further studies are needed to evaluate the long-term results of sleep quality on patients with endometrial cancer.Öğe Successful preoperative treatment by plasmapheresis of hyperthyroidism with hydatidiform mole(AVES, 2018) Kirac, Cem Onur; Baldane, Suleyman; Kebapcilar, Ayse Gul; Ipekci, Suleyman Hilmi; Ucar, Mustafa Gazi; Celik, Cetin; Kebapcilar, LeventWe recently encountered the case of an 18-year-old female complaining of abdominal pain, fatigue, nausea, vomiting, tremor of the hands, and vaginal bleeding. Her blood test revealed highly elevated human chorionic gonadotropin (hCG) levels, suppressed thyroid-stimulating hormone (TSH) levels, and increased free thyroid hormone levels. Molar pregnancy and hyperthyroidism were suspected based on highly elevated hCG levels and suppressed TSH levels with the co-existence of ultrasono-graphic findings of the uterus and thyroid Doppler images. Her symptoms and thyroid hormone levels responded well to plasmapheresis. Subsequently, the patient underwent dilatation and curettage for hydatidiform mole. Histopathology of the products verified the diagnosis of complete hydatidiform mole with no invasion. The patient is currently stable, and her hCG and thyroid hormone levels are within normal reference ranges.Öğe Urethral Coitus in a Case of Vaginal Agenesis - Is Only Vaginoplasty Enough to Treat the Urinary Problems?(PREMCHAND SHANTIDEVI RESEARCH FOUNDATION, 2016) Ucar, Mustafa Gazi; Ilhan, Tolgay Tuyan; Kebapcilar, AysAyse Gul; Tosun, Zekeriya; Celik, CetinUrethral coitus is an extremely rare condition. Megalourethra and urinary incontinence due to urethral coitus in vaginal agenesis are unusual manifestations because these patients usually present with primary amenorrhea before becoming sexually active and receive treatment. A 24-year-old woman came to our clinic because of primary amenorrhea, sexual dysfunction, dyspareunia, megalourethra and urinary incontinence five months after her marriage due to urethral coitus. Based on these clinical and radiological findings a diagnosis of Mayer-Rokitansky-Kuster-Hauser Syndrome was made and patient underwent modified McIndoe Vaginoplasty. The elasticity of female urethra permits repeated coitus, together with the physical damage can probably lead to incontinence. In this case, after eliminating the underlying cause of disease with vaginoplasty, no other treatment was required. The integrity of sphincteric function and structural support of urethra might be regained without subjecting the patient to aggressive reconstructive surgical procedures.Öğe Uterine Tumour Resembling Ovarian Sex Cord Tumour- A Rare Entity(PREMCHAND SHANTIDEVI RESEARCH FOUNDATION, 2016) Ucar, Mustafa Gazi; Ilhan, Tolgay Tuyan; Gul, Ayhan; Ugurluoglu, Ceyhan; Celik, CetinUterine Tumour Resembling Ovarian Sex-Cord Tumours (UTROSCTs) are an extremely rare type of uterine body tumours arising from the endometrial stroma. Epidemiology, aetiology, pathogenesis, management and natural history of UTROSCTs are still a question of debate, as there is little available data in the literature. Although rare, the possibility of UTROSCTs should be kept in mind, when a patient presents with abnormal bleeding and an enlarged uterus. utroscts appear dirty white/cream-coloured, gelatinous, well-circumscribed mass with smooth surface on macroscopic examination. We present a rare case of endometrial stromal tumour with sexcord-like differentiation which was successfully treated by hysterectomy with bilateral salpingo-oophorectomy. The clinical manifestations, pathologic characteristics, diagnosis and management of these tumours are reviewed here.
